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Sacral neuromodulation in nursing home residents: Predictors of success and complications in a national cohort of older adults.
Dreyfuss, Leo D; Nik-Ahd, Farnoosh; Wang, Lufan; Shatkin-Margolis, Abigail; Covinsky, Kenneth; John Boscardin, W; Suskind, Anne M.
Afiliación
  • Dreyfuss LD; Department of Urology, Weill Cornell Medical Center, New York, New York, USA.
  • Nik-Ahd F; Department of Urology, University of California-San Francisco, San Francisco, California, USA.
  • Wang L; Department of Urology, University of California-San Francisco, San Francisco, California, USA.
  • Shatkin-Margolis A; Department of Obstetrics and Gynecology, University of California, San Francisco, California, USA.
  • Covinsky K; Division of Geriatrics, University of California-San Francisco, San Francisco, California, USA.
  • John Boscardin W; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA.
  • Suskind AM; Department of Urology, University of California-San Francisco, San Francisco, California, USA.
Neurourol Urodyn ; 43(7): 1534-1544, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38624030
ABSTRACT

AIMS:

There is limited evidence to support the efficacy of sacral neuromodulation (SNM) for older adults with overactive bladder (OAB). This study aims to report outcomes following SNM among nursing home (NH) residents, a vulnerable population with high rates of frailty and comorbidity.

METHODS:

This is a retrospective cohort study of long-stay NH residents who underwent a trial of percutaneous nerve evaluation (PNE) or Stage 1 permanent lead placement (Stage 1) between 2014 and 2016. Residents were identified using the Minimum Data Set linked to Medicare claims. The primary outcome of this study was successful progression from trial to implant. Rates of 1-year device explant/revisions were also investigated.

RESULTS:

Trial of SNM was observed in 1089 residents (mean age 77.9 years). PNE was performed in 66.9% of residents and 33.2% underwent Stage 1. Of Stage 1 procedures, 23.8% were performed with simultaneous device implant (single-stage). Overall, 53.1% of PNEs and 72.4% of Stage 1 progressed to device implant, which was associated with Stage 1 procedure versus PNE (adjusted relative risk [aRR] 1.34; 95% confidence interval [95% CI] 1.21-1.49) and female versus male sex (aRR 1.26; 95% CI 1.09-1.46). One-year explant/revision was observed in 9.3% of residents (6.3% for PNE, 10.5% for Stage 1, 20.3% single-stage). Single stage procedure versus PNE was significantly associated with device explant/revision (aRR 3.4; 95% CI 1.9-6.2).

CONCLUSIONS:

In this large cohort of NH residents, outcomes following SNM were similar to previous reports of younger healthier cohorts. Surgeons managing older patients with OAB should use caution when selecting patients for single stage SNM procedures.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vejiga Urinaria Hiperactiva / Casas de Salud Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: Neurourol Urodyn Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vejiga Urinaria Hiperactiva / Casas de Salud Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: Neurourol Urodyn Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos